Schmidt T, Ulrich A
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
Radiologe. 2014 Feb;54(2):140-4. doi: 10.1007/s00117-013-2549-7.
Cancer of unknown primary site (CUP) comprises a relatively frequently occurring group of heterogeneous malignant tumors in the clinical routine, which currently has an abysmal prognosis for affected patients. Based on the improved diagnostic tools it is now possible to identify subgroups of patients with different clinical prognoses. New therapies adapted to these identified subgroups are becoming increasingly more relevant.
This review aims to evaluate the role of surgery and different surgical options in the therapy of patients with CUP.
For the treatment of patients with CUP it is important to identify subgroups of patients with a better prognosis. Surgical resection of CUP metastasis is a therapy option leading to a prolonged survival in (1) women with papillary peritoneal adenocarcinomatosis, (2) women with axillary lymph node metastasis of adenocarcinoma, (3) patients with cervical lymph node metastasis of squamous cell carcinoma, (4) patients with inguinal lymph node metastasis, (5) patients with poorly differentiated carcinomas with midline distribution (e.g. extragonadal germ cell syndrome) and (6) patients with small resectable tumors.
Surgery is an important therapy option in different subgroups of patients with CUP. Together with multimodal therapy, adjusted according to the identified most likely origin of the primary tumor, it is possible to prolong patient survival.
在临床实践中，原发灶不明的癌症（CUP）是一组相对常见的异质性恶性肿瘤，目前其对患者的预后极差。基于改进的诊断工具，现在有可能识别出具有不同临床预后的患者亚组。适用于这些已识别亚组的新疗法正变得越来越重要。
本综述旨在评估手术及不同手术方式在CUP患者治疗中的作用。
对于CUP患者的治疗，识别预后较好的患者亚组很重要。CUP转移灶的手术切除是一种能延长生存期的治疗选择，适用于以下患者：（1）患有乳头状腹膜腺癌病的女性；（2）患有腺癌腋窝淋巴结转移的女性；（3）患有鳞状细胞癌颈部淋巴结转移的患者；（4）患有腹股沟淋巴结转移的患者；（5）患有中线分布的低分化癌患者（如性腺外生殖细胞综合征）；（6）患有可切除小肿瘤的患者。
手术是CUP不同亚组患者的重要治疗选择。结合根据所识别的最可能的原发肿瘤起源进行调整的多模式治疗，有可能延长患者生存期。
